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TQuarry Lane estAmerica San Francisco <br /> Plea / q 15 <br /> 59 Test/ m ,rica <br /> Chain of Custody Record 7"� <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,'Dimple 720-9738.1 <br /> Client Contact: Phone. E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Analysis Requested 720-29904-1 <br /> Address: Due Date Requested: N0i,Preservation Codes: <br /> 2795 Second Street,Suite 300, 8!25/2010A-HCL M-Hexane <br /> City: TAT Requested(days): �- B-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> Zip: D-Nitric Acid P-Na204S <br /> State,Z <br /> CA,9 ip: E-NaHSO4 0-Na2SO3 <br /> `. F-MeOH R-Na2S2SC3 <br /> Phone, PO G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> a <br /> Email: WO M n -Ice U-Acetone <br /> >, J-Dl Water V-MCAA <br /> K-EDTA W-ph 4-5 <br /> Project Name: Project#: <br /> O L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 <br /> Site: SSOW#: _ Other: <br /> k <br /> Sample Matrix Zg <br /> Type (w.w.c. O <br /> ro Sample (C=comp, os .ua <br /> N :r.r n y <br /> tQ Sam le Identification-Client ID Lab ID Sam le Date Time G= rab er ns ,A An rn <br /> Special Instructions ote <br /> ,�� .,4&MID <br /> w all& <br /> 01% RC-1 (720-29904-1) 8/12/10 P09:05 Water X Q� <br /> acific e r <br /> 0 7717 Kiernan(720-29904-3) 8/12/10 11.12 Water X I Z <br /> I-h <br /> Pacific <br /> N a <br /> S <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard =Flammable Skin Irritant Poison B Unknown Radiological =Return To Client = Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II, III,IV,Other(specify) Special Instructions/QC Requirements: <br /> v Empty Kit Relinquished by: Date: Time: Method of shipment: <br /> (D Relinquished by. Date/Time: Company Received by: D Company <br /> W — t f <br /> Relinquished by. Date/Time: Company Received by: Daterrime: Company <br /> Relinquished by.,DaterTime: Company R ed Da :'O <br /> Custody Seals Intact: Custody Seal No.: Cooler emperature(s)'C and Other Remarks: 6 K `/��t• <br /> A Yes A No <br />